| 제목 |
Types of Detrusor-Sphincter Dyssynergia in the Spinal Cord Injured And Non-Neurogenic Bladder |
| 소속 |
Chonbuk National University Hospital, Department of Rehabilitation Medicine1, Chonbuk National University and Hospital, Research Institute of Clinical Medicine and Biomedical Research Institute2, Chonbuk National Universitiy Hospital, Department of Urology3, Chonbuk National University Hospital, Translational Research & Clinical Trial Center for Medical Device4, Chonbuk National University , Department of Speech-Language Therapy5 |
| 저자 |
Sung Woon Baik1,2*, Young-Bin Oh1,4, Gi-Wook Kim1,4, Yu Hui Won1,2, Sung-Hee Park1,2, Myoung-Hwan Ko1,4, Myung-Gi Kim3†, Jeong-Hwan Seo1,2† |
Objective
The urinary bladder function of storing and voiding urine is controlled by central and peripheral nervous systems. The pathophysiology of detrusor-sphincter dyssynergia (DSD) in neurogenic bladder is represented by disruption of spinobulbospinal tract between the pontine micturition center and Onuf’s nucleus. However, dyssynergic sphincter activity can also be seen in non-neurogenic bladder. In this retrospective study, we aimed to find out the differences of dyssynergic sphincter activity patterns and urodynamic parameters in the dysfunctional bladders of spinal cord injury (SCI) and the non-neurogenic (NN) patients.
Method
One hundred and seven patients of dysfunctional voiding who conducted urodynamic study from January to March, 2018 were enrolled retrospectively. They were divided into SCI group (n=32) and NN group (n=75) by reviewing their medical records. We categorized the urodynamic study findings into 5 types according to dyssynergic sphincter activities. Type 1-3 belonged to true DSD and type 4 belonged to pseudo-DSD. And, type 5 represented patients who didn’t show dyssynergic sphincter activity. We also analyzed their urodynamic parameters such as bladder capacity, compliance, detrusor leak point pressure (DLPP), peak detrusor pressure (PdetQmax), post-void residual urine volume (PVR) and electromyographic activity of the sphincter.
Results
37.3% (28 out of 75 patients) of NN group and 84.4% (27 out of 32 patients) of SCI group showed dyssynergic sphincter activity, respectively. Pseudo-DSD was shown in 3.6% (1 out of 28 patients) and 22.2% (8 out of 36 patients) prevalence in each SCI group and NN group. Bladder capacity was significantly higher in SCI group (mean=456.78) than NN group (mean=368.04) who had true DSD (p<0.05). There were no significant differences in other urodynamic parameters between SCI group and NN group. And, DLPP, PdetQmax, and PdetQmax (flow) were significantly higher in true DSD group (mean=30, 45, 39, respectively) than pseudo-DSD group (mean=18.78, 25.56, 18.33, respectively) in all patients.
Conclusion
Detrusor-sphincter dysfunction was not infrequent in patients with NN bladder. And those who have cord injury had higher bladder capacity than non-neurogenic bladder among true dyssynergic sphincter dyssynergia. Also, pseudo-DSD which caused by contraction of abdominal muscle or pelvic floor muscle can be shown not uncommonly during the urodynamic study. Further studies with prospective and good design are necessary for more valuable clinical findings.
Key words Detrusor-sphincter dyssynergia, Neurogenic bladder, Dysfunctional voiding |
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